Reactions 1680, p98 - 2 Dec 2017 Tenosynovitis caused by Phaeoacremonium parasiticum: case report A 63-year-old man developed tenosynovitis caused by Phaeoacremonium parasiticum infection during treatment with methotrexate, prednisone and cortivazol [not all routes and dosages stated]. The man was receiving treatment with prednisone 7 mg/day and methotrexate 20 mg/week for seropositive rheumatoid arthritis diagnosed in 1999. He also had a history of diabetes mellitus. In April 2013, he presented with extensor tenosynovitis of the right hand. A subsequent aspirate culture was found negative. Subsequently, he received a local injection of cortivazol. Due to the persistent signs, he received a second injection of cortivazol in December 2013. In March 2014, his pain and synovitis of the right wrist worsened and the overlying skin was warm to touch. Due to a suspicion of septic arthritis, he was admitted. A 5mL of chocolate-brown purulent fluid was recovered on aspiration and the aspirate cultures were found positive for Phaeoacremonium parasiticum. After joint irrigation, incision and drainage of the subcutaneous abscess rice soup-like pus was obtained. The man’s treatment with methotrexate was discontinued and he was administered voriconazole for 6 weeks, following which his infection resolved. After over 12 months of follow- up with no evidence of recurrence, the methotrexate was restarted along with abatacept. At last follow-up, he remained free of recurrence and had experienced no other serious infections. Author comment: "We report a case of tenosynovitis caused by Phaeoacremonium parasiticum in a 63-year-old patient taking methotrexate and glu-cocorticoid therapy". "Deep fungal infections are uncommon events seen chiefly in immunocompromised individuals. Among them, tenosynovitis is exceedingly rare." "Phaeohyphomycosis is an emerging infection that often causes major disease in immunocompromised patients." Truffaut S, et al. Phaeohyphomycotic tenosynovitis after local steroid injection during methotrexate therapy for rheumatoid arthritis: A case-report. Joint Bone Spine 84: 743-744, No. 6, Dec 2017. Available from: URL: http://doi.org/10.1016/ j.jbspin.2016.11.005 - France 803284396 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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